Floods and humanitarian medicine

Unlike spontaneous volunteers, healthcare professionals must think critically to avoid overwhelming the local resources and decide where in the disaster cycle they would be most effective

“Bani Adam aaza’ e yak o deegarand,

Keh der aafreenesh ze yak gauharand.

Choon uzvi ba dard aaward rozgar,

Digar uzvha ra na manand qarar.

Tu keh az mehnat-e-deegran beghami,

Nashayad keh naamet nahad aadmi.”

(Human beings are members of a whole,

In creation, of one essence and soul.

If one member is afflicted with pain,

Other members uneasy will remain.

If you have no sympathy for human pain,

The name of human you cannot retain) — from Gulistan by Saadi Shirazi, adorning the UN Hall of Nations.

It is perhaps the overall dominance of this spirit of mankind being one whole that its members continue to feel the pain of others, despite the mind-numbing barbarism, doom and gloom coming our way in recent years.

When struck by a disaster, the predominant response of people is empathy, support and a desire to channelise these sentiments, through direct or indirect means, into tangible help for the affected group. In many instances this altruism has to take the form of physical participation, making the process tangible — and thus satisfactory — for the helper as well. This direct involvement in assisting the affected population, beyond donating supplies or money, constitutes volunteerism.

Generally, the spontaneous volunteer activity in the early response phases of a disaster is important and helpful. But if not properly coordinated, the convergence of untrained and trained volunteers has the potential to adversely affect and overwhelm the disaster management, as was observed in the US in the aftermath of the 9/11 tragedy and Hurricane Katrina.

Hurricane Katrina also raised several straightforward but ominous public health concerns like water safety, sanitation and hygiene, infection control and immunisations and restoring access to healthcare. That these issues needed to be addressed was obvious but much more complicated was how.

Flooding is the most common natural disaster but our scientific understanding of the health effects of the floods is disappointingly limited. Another factor hampering an effective public health response after the floods is that studies conducted in developed countries have limited application in what we are experiencing in Pakistan.

Even within the US a serious disconnect was reported between the healthcare needs of the Katrina victims and the objectives of the volunteer physicians who came in to help. In a letter to the editor, published in the New England Journal of Medicine, a Louisiana physician, Dr Katharine Rathbun had lamented that they did not need more thoracic surgeons or emergency physicians; what the displaced people needed was access to primary care for their chronic illnesses like diabetes, heart or lung diseases.

The above noted paraphrase of Dr Rathbun’s letter captures the essence of humanitarian or disaster medicine: when natural or manmade disasters bring health issues to the fore, the international medical community is expected more than ever to address the needs of the most vulnerable. However, along with the urge to do more, and quickly, avoiding a disconnect with the affected community and its needs is a must. Unlike spontaneous volunteers, healthcare professionals must think critically to avoid overwhelming the local resources and decide where in the disaster cycle they would be most effective. For example, there could be a long delay before local healthcare systems can function during the recovery phase and the volunteer medics could provide significant help during this hiatus.

Thousands of medical professionals in Pakistan are working day and night to deliver healthcare and relief supplies to the millions affected by the floods, as we speak. In addition, groups like the Association of Physicians of Pakistani-descent of North America (APPNA) are coordinating their relief work through colleagues on the ground in Pakistan. The Student Welfare Society of the Khyber Medical College (SWS-KMC), Peshawar is one such entity that has been working closely with APPNA and the college’s North American alumni association. The group, led by the college vice principal, Professor Ejaz Hassan and staffed by the faculty and students, has been conducting relief activities in Nowshera, Charsadda, Swat and D I Khan since early August. APPNA’s president visited the flood-ravaged areas of Punjab, Sindh and Khyber Pakhtunkhwa, including the APPNA-sponsored relief camps, early last month for a needs assessment. The SWS-KMC and APPNA will now adopt two villages in Charsadda and Nowshera for the ongoing relief efforts. The King Edward Medical College Alumni of North America has just announced adopting a village in Muzaffargarh for rebuilding and rehabilitation. Another group of Pakistani-American doctors in Kentucky and Indiana is working in earnest to deliver water-purifying units to Pakistan.

These efforts are accompanied by active fundraising campaigns by individuals in the medical fraternity and organised groups like the alumni groups and APPNA. More than $ 500,000 have been pledged to APPNA while the Association of Pakistani Physicians of Kentucky and Indiana has raised above $ 200,000 through the efforts of its young leaders.

While the need for practicing humanitarian medicine is urgent and unlimited, unplanned volunteerism could also be chaotic. Dr David Welling et al in their article ‘Seven sins of humanitarian medicine’ (World Journal of Surgery, March 2010), have cautioned medical volunteers against: “1. Leaving a mess behind. 2. Failing to match technology to local needs and abilities. 3. Failing of NGOs to cooperate and help each other, and accept help from local organisations. 4. Failing to have a follow-up plan. 5. Allowing politics, training, or other distracting goals to trump service, while representing the mission as ‘service’. 6. Going where we are not wanted, or needed and/or being poor guests. 7. Doing the right thing, for the wrong reason.”

As the floodwaters recede, medical professionals, including those in the US, must brainstorm to determine a cogent course of action to provide continued assistance. Prudence demands that Pak-American physician leaders dedicate their working meetings to actively engage US and international agencies to plan and fund projects to rebuild the healthcare delivery system. Liaising with the National Disaster Management Agency (NDMA), the UN Office for Coordination of Humanitarian Affairs, medical teaching institutions and the civilian and military authorities on the ground, could help avoid a well-meaning but fragmented effort. While alleviating the pain of afflicted mankind, first, we must do no harm.

(Note: The views expressed are the writer’s opinion and do not represent any of the organisations mentioned)